In my experience, most people who directly request medical assistance in dying have already come a long way and are at a stage where palliative care is not the outcome they envision. This can particularly affect people who have a neurodegenerative disease and who see themselves declining. I'm thinking of amyotrophic lateral sclerosis, ALS, also known as Lou Gehrig's disease, among others. They receive care, but it cannot necessarily be called palliative care. Although they have support, these people have chosen a critical juncture past which they do not want to receive intensive palliative care, but rather receive medical assistance in dying.
On October 7th, 2022. See this statement in context.